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Positivity Rate of [18F]Fluciclovine PET/CT in Patients with Suspected Prostate Cancer Recurrence at PSA Levels Below 1 ng/mL

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Abstract

Purpose

Early and precise localization of recurrent prostate cancer lesions after local therapy facilitates optimal disease management. Here, we present results from a single-center study to evaluate the utility of [18F]fluciclovine PET/CT to localize prostate cancer recurrence in patients with PSA <1 ng/mL.

Procedures

Data from men who underwent [18F]fluciclovine PET/CT (August 2016–March 2020) for suspected recurrent prostate cancer and who had a PSA value <1ng/mL were retrospectively reviewed. The number of positive scans (positivity rates, PR) was calculated for the whole body, prostate/bed, and extraprostatic regions (pelvic or extrapelvic lymph nodes, bones, and soft tissue). PR were stratified by pre-scan PSA.

Results

Data from 113 patients were included. In total, 98 (87%) were post-prostatectomy and 15 (13%) had received non-surgical primary therapy. Twenty patients (18%) were receiving ADT at the time of the scan, 91 (81%) were not, and ADT status was not known for 2 (1.8%) patients. The overall PR at PSA <1ng/mL was 59% (67/113). For the prostate/bed, it was 35% (40/113), and for extraprostatic locations, it was 37% (42/113). At PSA >0–<0.2, 0.2–<0.5, and 0.5–<1 ng/mL, the overall PR was 43% (10/23), 70% (35/50), and 55% (22/40), respectively. In the prostate/bed, these were 13% (3/23), 50% (25/50), and 30% (12/40), respectively, and in extraprostatic lesions were 30% (7/23), 44% (22/50), and 33% (13/40), respectively. Pelvic lymph nodes were the most common site for extraprostatic lesions (29/113, 26%). PR in extrapelvic lymph nodes, bone, and soft tissue were 8.0%, 12%, and 3.5%, respectively. Soft tissue lesions comprised lung nodules (n=3) and a perirectal mass implant (n=1).

Conclusions

Despite low PSA values, more than half of patients had positive [18F]fluciclovine PET/CT findings. Patients with low PSA levels may demonstrate suspicious findings outside of the pelvis, including abdominal lymph nodes and metastatic disease to bones and lungs.

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References

  1. Mottet N, Bellmunt J, Briers E, et al. The EAU prostate cancer guidelines. 2020. http://uroweb.org/guideline/prostate-cancer. Accessed August 2021.

  2. Ferlay J, Ervik M, Lam F, et al. Global cancer observatory: cancer today. 2020. https://gco.iarc.fr/today. Accessed August 2021.

  3. Stephenson AJ, Scardino PT, Kattan MW et al (2007) Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25:2035–2041

    Article  Google Scholar 

  4. Tendulkar RD, Agrawal S, Gao T et al (2016) Contemporary update of a multi-institutional predictive nomogram for salvage radiotherapy after radical prostatectomy. J Clin Oncol 34:3648–3654

    Article  Google Scholar 

  5. King CR (2012) The timing of salvage radiotherapy after radical prostatectomy: a systematic review. Int J Radiat Oncol Biol Phys 84:104–111

    Article  Google Scholar 

  6. Vargas HA, Martin-Malburet AG et al (2016) Localizing sites of disease in patients with rising serum prostate-specific antigen up to 1ng/ml following prostatectomy: how much information can conventional imaging provide? Urol Oncol 34(482):e5–e10

    Google Scholar 

  7. Malone S, Croke J, Roustan-Delatour N et al (2012) Postoperative radiotherapy for prostate cancer: a comparison of four consensus guidelines and dosimetric evaluation of 3D-CRT versus tomotherapy IMRT. IJROBP 84:725–732

    Google Scholar 

  8. Jani AB, Schreibmann E, Goyal S et al (2021) 18F-fluciclovine-PET/CT imaging versus conventional imaging alone to guide postprostatectomy salvage radiotherapy for prostate cancer (EMPIRE-1): a single centre, open-label, phase 2/3 randomised controlled trial. The Lancet 397:1895–904

    Article  CAS  Google Scholar 

  9. Scarsbrook AF, Bottomley D, Teoh EJ et al (2020) Impact of 18F-fluciclovine positron emission tomography on the management of patients with recurrence of prostate cancer: Results from the FALCON trial. IJROBP 107:316–324

    Google Scholar 

  10. Schuster DM, Nieh PT, Jani AB et al (2014) Anti-3-[18F]FACBC positron emission tomography-computerized tomography and 111In-capromab pendetide single photon emission computerized tomography-computerized tomography for recurrent prostate carcinoma: results of a prospective clinical trial. J Urol 191:1446–1453

    Article  Google Scholar 

  11. Andriole GL, Kostakoglu L, Chau A et al (2019) The impact of positron emission tomography with 18F-fluciclovine on the management of patients with biochemical recurrence of prostate cancer: results from the LOCATE trial. J Urol 201:322–331

    Article  Google Scholar 

  12. Pernthaler B, Kulnik R, Gstettner C et al (2019) A prospective head-to-head comparison of 18F-fluciclovine with 68Ga-PSMA-11 in biochemical recurrence of prostate cancer in PET/CT. Clin Nucl Med 44:e566–e573

    Article  Google Scholar 

  13. Rais-Bahrami S, Efstathiou JA, Turnbull CM et al (2021) 18F-Fluciclovine PET/CT performance in biochemical recurrence of prostate cancer: a systematic review. Prostate Cancer Prostatic Dis. https://doi.org/10.1038/s41391-021-00382-9

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tade FI, Sajdak RA, Gabriel M et al (2019) Best practices for 18F-fluciclovine PET/CT imaging of recurrent prostate cancer: a guide for technologists. J Nucl Med Tech 47:282–287

    Article  Google Scholar 

  15. Nanni C, Zanoni L, Bach-Gansmo T et al (2020) [18F]Fluciclovine PET/CT: joint EANM and SNMMI procedure guideline for prostate cancer imaging-version 1.0. EJNMMI 47:579–591

    Google Scholar 

  16. Savir-Baruch B, Banks KP, McConathy JE et al (2018) ACR-ACNM practice parameter for the performance of fluorine-18 fluciclovine-PET/CT for recurrent prostate cancer. Clin Nucl Med 43:909–917

    Article  Google Scholar 

  17. Blue Earth Diagnostics. Axumin prescribing information at: https://www.axumin.com/prescribing-information.pdf. Accessed August 2021.

  18. Pisansky TM, Thompson IM, Valicenti RK et al (2019) Adjuvant and salvage radiotherapy after prostatectomy: ASTRO/AUA guideline amendment 2018–2019. J Urol 202:533–538

    Article  Google Scholar 

  19. Bach-Gansmo T, Nanni C, Nieh PT et al (2017) Multisite experience of the safety, detection rate and diagnostic performance of fluciclovine (18F) positron emission tomography/computerized tomography imaging in the staging of biochemically recurrent prostate cancer. J Urol 197:676–683

    Article  Google Scholar 

  20. Dreyfuss AD, Ahn GS, Barsky AR et al (2021) 18F-Fluciclovine PET/CT in therapeutic decision making for prostate cancer: a large single-center practice-based analysis. Clin Nucl Med 46:187–194

    Article  Google Scholar 

  21. Krohn T, Birmes A, Winz OH et al (2017) The reconstruction algorithm used for [68Ga]PSMA-HBED-CC PET/CT reconstruction significantly influences the number of detected lymph node metastases and coeliac ganglia. Eur J Nucl Med Mol Imaging 44(4):662–9

    Article  CAS  Google Scholar 

  22. Teyateeti A, Teyateeti A, Ravizzini GC, et al (2021) Diagnostic performance of 18F-fluciclovine PET/CT in prostate cancer patients with rising PSA level ≤ 0.5 ng/ml after multiple treatment failures. Am J Nucl Med Mol Imaging 11(2):87–98

  23. Teyateeti A, Teyateeti A, Macapinlac HA, Lu Y (2020) Is there any role for F-18 fluciclovine PET/CT in the presence of undetectable PSA in prostate cancer patients after definitive treatment? Clin Nucl Med 45:672–678

    Article  Google Scholar 

  24. Malviya G, Patel R, Salji M et al (2020) 18F-Fluciclovine PET metabolic imaging reveals prostate cancer tumour heterogeneity associated with disease resistance to androgen deprivation therapy. EJNMMI Res 10:143

    Article  CAS  Google Scholar 

  25. England JR, Paluch J, Ballas LK, Jadvar H (2019) 18F-Fluciclovine PET/CT detection of recurrent prostate carcinoma in patients with serum PSA ≤ 1 ng/mL after definitive primary treatment. Clin Nucl Med 44:e128–e132

    Article  Google Scholar 

  26. Gandaglia G, Abdollah F, Schiffmann J et al (2014) Distribution of metastatic sites in patients with prostate cancer: a population-based analysis. Prostate 74:210–216

    Article  Google Scholar 

  27. Hess KR, Varadhachary GR, Taylor SH et al (2006) Metastatic patterns in adenocarcinoma. Cancer 106:1624–1633

    Article  Google Scholar 

  28. Paño B, Sebastià C, Buñesch L et al (2011) Pathways of lymphatic spread in male urogenital pelvic malignancies. Radiographics 31:135–160

    Article  Google Scholar 

  29. NCCN. NCCN clinical practice guidelines in oncology: prostate cancer. Version 4.2019. https://www2.tri-kobe.org/nccn/guideline/urological/english/prostate.pdf 2019. Accessed August 2021.

  30. Kim EH, Siegel BA, Teoh EJ, Andriole GL, LOCATE Study Group (2021) Prostate cancer recurrence in patients with negative or equivocal conventional imaging: a role for 18F-fluciclovine-PET/CT in delineating sites of recurrence and identifying patients with oligometastatic disease. Urol Oncol 39(365):e9–e16

    Google Scholar 

  31. Armstrong JM, Martin CR, Dechet C et al (2020) 18F-fluciclovine PET CT detection of biochemical recurrent prostate cancer at specific PSA thresholds after definitive treatment. Urol Oncol 38(636):e1–e6

    Google Scholar 

  32. Savir-Baruch B, Choyke PL, Rowe SP et al (2021) Role of 18F-fluciclovine and prostate-specific membrane antigen PET/CT in guiding management of oligometastatic prostate cancer: AJR expert panel narrative review. AJR 216:851–859

    Article  Google Scholar 

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Acknowledgements

Medical writing support was provided by Dr Catriona Turnbull (BED).

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Authors and Affiliations

  1. Department of Radiology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL, 60153, USA

    Jad El Bulbul, Damian Grybowski, Petra Lovrec, Medhat S. Gabriel, Robert H. Wagner & Bital Savir-Baruch

  2. Department of Radiation Oncology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL, 60153, USA

    Abhishek A. Solanki

Authors
  1. Jad El Bulbul
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  2. Damian Grybowski
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  4. Abhishek A. Solanki
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  7. Bital Savir-Baruch
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Contributions

Study conception and design: BSB. Material preparation and data collection: JEB, PL, DG, BSB. All authors participated in data analysis and in drafting and reviewing the manuscript.

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Correspondence to Bital Savir-Baruch.

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Conflict of Interest

B. Savir-Baruch reports receiving research grants from Blue Earth Diagnostics. The authors have no further relevant financial or non-financial interests to disclose.

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Bulbul, J.E., Grybowski, D., Lovrec, P. et al. Positivity Rate of [18F]Fluciclovine PET/CT in Patients with Suspected Prostate Cancer Recurrence at PSA Levels Below 1 ng/mL. Mol Imaging Biol 24, 42–49 (2022). https://doi.org/10.1007/s11307-021-01644-7

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  • DOI: https://doi.org/10.1007/s11307-021-01644-7

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